If germs invade the soft tissues below the superficial level of the skin (the “epidermis”), they can rapidly infect the main layers of soft tissue below. These include the deep layer of the skin (the “dermis”), the subcutaneous fat, the muscle layers, and various blood vessels and nerves.
Cellulitis may be easy to deal with in normal times, but it will be an epidemic in the aftermath of a major disaster. This is not because it’s contagious; it isn’t unless you have an open wound yourself or exchange bodily fluids. Expect cases simply because of the sheer number of injuries incurred from performing activities of daily survival in less than sanitary conditions.
Without antibiotics, infections can spread to lymph nodes and the bloodstream, rapidly becoming life-threatening. The end result might affect the entire body, referred to as “sepsis.” Once sepsis develops, inflammation of deep structures like the spinal cord (“meningitis”) or bone marrow (“osteomyelitis”) can further complicate the situation. In the past, sepsis was usually fatal.
The bacteria that can cause cellulitis are on your skin right now. Normal inhabitants of the surface of your skin include Staphylococcus and Group A Streptococcus. They do no harm until the skin is broken and they enter deeper tissues where they don’t belong. In recent years, a resistant bacterium called MRSA (Methicillin-Resistant Staphylococcus Aureus) has arisen which causes cellulitis resistant to the usual antibiotics.
As an aside, Cellulitis has nothing to do with the dimpling on the skin called “cellulite”. The suffix “-itis” simply means “inflammation”, so cellul-itis simply means “inflammation of the cells.”
Heat in the area of the infection compared to non-affected areas
Redness, usually spreading towards torso
Swelling in the area of infection (often appearing shiny and causing a sensation of tightness)
Drainage of pus or cloudy fluid from the area of the infection
Foul odor coming from the area of infection
Hair loss at the site of infection (less common)
Joint stiffness caused by swelling of the tissue over it (less common)
Cellulitis commonly occurs in an extremity, such as a leg. In these cases, it’s helpful to keep the limb elevated. Other strategies include warm or cool compresses or soaks to the affected area, and the use of ibuprofen (Advil) or acetaminophen (Tylenol) to decrease pain, discomfort, and fever.
As most cases of cellulitis are caused by bacteria, they should improve and disappear during a 7-14-day course of therapy with medications in the Penicillin, Erythromycin, or Cephalosporin (Keflex) families. Amoxicillin and ampicillin are particularly popular. MRSA cellulitis can be treated with clindamycin and the sulfa drug combination of sulfamethoxazole/trimethoprim (SMX-TMP). It’s important to complete the full course of therapy.
Adult dosing:
-Penicillin, amoxicillin, cephalexin, or ampicillin 250-500 mg orally four times a day for 7-14 days (Amoxicillin also comes in 875 mg).
-Clindamycin 150-300 mg orally three times a day for 7-10 days.
-SMX 800 mg-TMX 160 mg orally twice a day for 7-10 days.
Those allergic to penicillins can still take clindamycin or SMX-TMP. It should be noted that not all sources will recommend the same dosage, frequency, and duration of therapy for a particular drug. In resistant infections like MRSA, combination therapy with SMX/TMP and Cephalexin 500 mg orally four times a day for 7-14 days may be necessary.
As with all medications, the longer the therapy and the higher the dose, the more likelihood that adverse reactions may occur. A much more comprehensive discussion of antibiotics can be found in Alton’s Antibiotics and Infectious Disease: The Layman’s Guide, or online at drugs.com and rxlist.com.
All the drugs mentioned above are available in veterinary equivalents (at least at present). In a survival situation, however, antibiotics will be precious commodities. You, as medic, should dispense them only when absolutely necessary. The misuse of antibiotics, along with their excessive use in livestock, is part of the reason that we’re seeing an epidemic of antibiotic resistance in this country.
The Altons at Doom and Bloom Medical have an article up on Cyclospora Infection.
Food contamination is a constant concern in the United States, especially from imported produce. In normal times, U.S. citizens take for granted the ability to buy bananas in Montana in February. As long as we import food, we must be especially careful to eliminate subtropical and tropical pathogens from our food.
A number of different disease-causing organisms especially put humans at risk; one of these is Cyclospora cayetanensis. From May to late August, 2020, more than 1100 laboratory-confirmed cases of food contamination due to Cyclospora (known as cyclosporiasis) were reported in 34 states. In most cases, fresh imported produce, especially greens and vegetables, were identified as likely origins.
Cyclospora is a one-celled parasite that is a natural inhabitant of the tropics and subtropics, where it seems to cause outbreaks that are seasonal in nature. The U.S. cases, however, occurred in people who had not recently visited the tropics before symptoms began.
THE LIFE CYCLE OF CYCLOSPORA
Cyclospora is spread by people ingesting food or water contaminated with feces containing Cyclospora oocysts (essentially a thick-walled fertilized ovum). Unlike some similar parasites, however, the oocyst needs time (usually, at least 1–2 weeks) after being passed in a bowel movement to become infectious. Therefore, it’s unlikely that Cyclospora can be passed directly from one person to another. More likely, the oocysts contaminate crops or water sources.
SYMPTOMS OF CYCLOSPORIASIS
Exactly how food and water becomes contaminated with Cyclospora oocysts isn’t fully understood but, once the oocysts “hatch” in the human body, the microbes enter the intestinal wall. Some symptoms then begin to manifest. They start an average of 7 days after ingestion of the infective version of the oocyst and can include the following:
Watery diarrhea (most common)
Loss of appetite
Low-grade fever
Weight loss
Cramping
Bloating, increased gas
Nausea and vomiting
Fatigue
A typical case would cause watery diarrhea, with frequent, sometimes explosive, bowel movements. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Interestingly, some people infected with Cyclospora have no symptoms at all.
If untreated, the illness endures for a few days, but some cases last a month. Some victims experience improvement and then relapse several times during the progress of the infection. Although not life-threatening, long-term fatigue and other problems are a possibility.
The Complex Life Cycle of Cyclospora
TREATMENT
Once the organism is identified in a stool sample, cyclosporiasis can be effectively treated with the combination sulfa drug trimethoprim-sulfamethoxazole (TMP-SMX). The usual regimen for adults is trimethoprim (TMP) 160 mg plus sulfamethoxazole (SMX) 800 mg (one double-strength tablet) twice daily for 7–10 days. The veterinary equivalent is FISH-SULFA FORTE. No effective alternatives have been identified yet for those allergic to sulfa drugs. In this case, most immune-competent people will recover without treatment and with good hydration.
PREVENTION
Avoiding any food or water that might be contaminated with feces is the best way to prevent infection. Routine chemical disinfection is less effective for Cyclospora than for most other bacteria or parasites.
1)Washing hands with soap and warm water after touching fruits and vegetables. Also, be sure to clean cutting boards, dishes, utensils, and counter tops between the preparation of meat, poultry, and seafood and fruits and vegetables.
2)Preparing all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Remove any damaged or bruised areas on fruits and vegetables. Firm items like cucumbers or melons should be scrubbed with a clean brush dedicated to the purpose.
3)Storing properly by refrigerating cut, peeled, or cooked fruits and vegetables within two hours (preferable sooner). Separate the storage of fruits and vegetables and raw meat, poultry, and seafood.
It should be noted that routine chemical disinfection is less effective for Cyclospora than for most other bacteria or parasites. No vaccine exists and immunity isn’t long-term: Recurrence of infection is not uncommon if re-exposed.
The Altons at Doom and Bloom Medical have an article up describing cryptosporidium parasite infections – symptoms, treatment, and prevention.
Summertime is when you cool off with a dip in the pool, but this year you might be sorry you did. The Centers for Disease Control and Prevention are urging citizens to protect themselves against a hardy parasite called Cryptosporidium.
Public and private pools alike are being colonized with the nasty bug, better known as “Crypto”. The organism lives in the intestines of infected people and animals. Crypto spreads in pool water when someone who is sick with the parasite goes swimming and has a loose bowel movement in the water. Because of their more liquid nature, diarrheal stools spread the microbe faster than formed ones.
Cryptosporidium is so tough that it can live for up to ten days in the presence of bleach. This year, there are more outbreaks in recreational waters than usual. The frequency has risen an average of 13% annually since 2009. In the last decade, over 400 incidents were reported in the U.S., leading to sickness in 7,500 people.
Note: Organisms that cause sickness in a population are known as “pathogens”.
Swallowing water from pools, hot tubs, and swimming holes isn’t the only way you can get infected. Day care centers and other venues with a large number of small children can also lead to contamination. Contact with infected animals may also pass the organism.
SYMPTOMS OF CRYPTO INFECTIONS
Crypto lives here
Infection with Crypto leads to a disease called “cryptosporidiosis”. Within two to ten days after exposure, the victim starts to have nausea, vomiting, and watery diarrhea that can last for weeks. Other symptoms of the illness may include fever, stomach cramps, and weight loss…
Lower Valley Assembly 